Provider First Line Business Practice Location Address:
3005 N ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358-2984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-738-7789
Provider Business Practice Location Address Fax Number:
910-738-7599
Provider Enumeration Date:
10/07/2005